What is percutaneous lithotripsy?
Percutaneous lithotripsy, also known as percutaneous nephrolithotomy or PNL, is an endoscopic procedure that allows the removal of kidney stones by introducing instruments such as a nephroscope, lithotripsy probes (laser, ultrasound, etc.) and forceps through a passage between the renal parenchyma and the skin.
Percutaneous nephrolithotomy allows the removal of kidney stones with minimal incision.
Why is it performed?
Percutaneous lithotripsy is considered the most appropriate therapy to treat the following conditions:
- Kidney stones larger than 2 cm in size.
- Calyceal stones larger than 1.5 cm in size
- Calyceal diverticulum calyceal stones
- Anatomical alterations that do not allow the removal of cystine calculi larger than 1.5 cm.
It is not indicated to resort to this technique in case of:
- Urinary tract infections, especially if they are acute.
- Coagulopathies
- COPD (Chronic Obstructive Pulmonary Disease)
- Skeletal deformities that prevent the patient from being in the proper position to perform the procedure.
What does it consist of?
Percutaneous nephrolithotomy has a variable duration (40-150 minutes), it is generally performed under general or high epidural anesthesia with the patient in prone position. It consists in the placement of a ureteral catheter by the urologist, who then inserts a needle into the renal cavities through which the nephroscope is also inserted. The renal stone will then be fragmented thanks to probes that can be ultrasound or use ballistic, laser or electrohydraulic energy (the type of energy used varies according to the size and consistency of the stone).
Preparation for percutaneous lithotripsy
Before performing a percutaneous nephrolithotomy, the patient must undergo antibiotic prophylaxis according to the specialist’s instructions.
Recovery after treatment
After a PNL, a radiological control will be performed, if necessary with contrast, to check the correct removal of the kidney stones. The specialist will also recommend periodic controls to prevent eventual relapses and, after 8-10 days of removal, the patient will be able to resume normal daily activities.
Alternative treatments
An alternative treatment for the removal of kidney stones is open surgery (pyelolithotomy) which involves an incision in the hip and, after placement of an auto-static ureteral catheter, repeated extracorporeal shock wave lithotripsy. However, this technique involves slower stone expulsion, with risk of infection and functional loss of the kidney.